Customized knee replacement

Middletown Medical brings new surgical procedure to Bon Secours

Dr. Robert P. Mantica, an orthopedic surgeon with Middletown Medical P.C., started a sports medicine clinic in Bethesda, Md., while in the Navy. It was there he introduced arthroscopic surgery of the shoulder and knee.

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By Deborah J. Botti

recordonline.com

By Deborah J. Botti

Posted Mar. 19, 2013 at 2:00 AM

By Deborah J. Botti

Posted Mar. 19, 2013 at 2:00 AM

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Dr. Robert P. Mantica, an orthopedic surgeon with Middletown Medical P.C., started a sports medicine clinic in Bethesda, Md., while in the Navy. It was there he introduced arthroscopic surgery of the shoulder and knee.

For those all-too-common knee ligament tears caused by quick run-stop-turn maneuvers found in football, basketball, skiing, aerobic exercise and dance — to name a few — minimally invasive ligament reconstruction is available.

"Ligaments are the fibrous tissue that holds bones together," Mantica says. "Using cadaver graft and two half-inch incisions and one less-than-an-inch incision, the injury can be repaired."

If the cause of knee pain is severe arthritic changes or traumatic injuries from a car crash, for example, resulting in painful inflammation, he offers another state-of-the-art approach.

"My total knee replacement is a little different. I use instrumentation developed in conjunction with a 3-D MRI scan that allow us to make accurate cuts ... customized for the patient," Mantica says.

He stresses, though, that total knee replacement is not the first line of defense.

"If pain does not respond to rest or over-the-counter pain relievers, then the first step is to get a real diagnosis to see what's going on," he says.

If a torn cartilage is the culprit, for example, then walking can irritate the joint surfaces even more. The torn cartilage needs to be addressed to prevent further damage, he says.

"And not everyone with arthritis needs knee replacement," he says. "Lots of time there's plenty we can do without surgery."

Such as:

-- Hyaluronic acid — a normal component of joint fluid — can be injected into the knee to increase nutrition and improve symptoms

-- Steroid injections

-- Physical therapy

-- Weight loss. Excess weight is certainly a stressor, Mantica says, with each additional pound actually putting three additional pounds of pressure on the knee joint.

-- Anti-inflammatory medications. Mantica says while there is anecdotal information from some patients as to the benefits of glucosamine-chondroitin supplements, this is not yet backed by scientific studies.

But if the pain continues and total knee replacement is deemed appropriate, Mantica says this is a good operation with a 25-year history — and more recent tweaking to make it even better.

"Our aim is to get people back to their status before they were disabled by the arthritis," he says. "In an older person, that often means maintaining mobility, while a younger person who was injured might have a totally different expectation."

Mantica says knee replacement is really knee resurfacing.

"The arthritic surfaces are cut off," he says, based on guides patterned from the 3-D MRI scans of the patient's own knee. "Before, we had to eyeball it. These instruments take the guesswork out."

The cuts are made. Then, either metal and/or high-density plastic that's molded to fit the ends of the patient's tibia, or shinbone, and femur, or thighbone, are precisely placed and cemented.

"The patient ends up with a knee at the right location and the right position," he says of the surgery by a dedicated team, which typically requires a three-day hospital stay. Some people are discharged to their homes; others, typically older patients or those with more complicated medical histories, spend subsequent time in a rehab unit.

"I also use an injection all around the capsule of soft tissue around the knee with a long-acting numbing agent and a little steroid," he says. "This cuts out a lot of the pain."

A total knee replacement gives about 20-30 years of pain-free walking, bicycling, stair-climbing, etc.

"I discourage really vigorous, stop-start sports. That can cause loosening," Mantica says. "And while it's not quite the same as the original knee, it's pretty close."